The PANY Bulletin

Psychoanalytic Association of New York
Volume 39, Number 2 Summer 2001

Revised Ethics Code Approved by the American Psychoanalytic Association
by Rita Clark, M.D.

For the past several years a committee of the American Psychoanalytic Association has been working on revising the Code of Ethics. The revision has been passed by the Executive Council. The new code is much more specific and detailed in its recommendations and will be accompanied by a Casebook which illustrates the general principles and has discussions that bring out the various factors involved in making ethical decisions.

An example that covers a not uncommon situation is the part of the old code that says: Do not render professional service to the patient of a colleague, including therapists in allied professions, without the colleague' s knowledge, unless it is in the best interests of the patient to do so. Patients should inform their therapists that they want a consultation or a change, or if they have not done so, notify the other therapist yourself, with consent of patient, as soon as may be practicable.

The new code states the analyst may consult with patients of another person without notifying them or forcing the patient to do so. The analyst may intervene with another treatment when there is indication of incompetence of the analyst. The emphasis is on protecting the patient more than on maintaining collegial relationships. It should not be made difficult for patients to leave ineffective or even destructive analyses, and it should not be assumed that a wish to change analyst s is an acting out and should be uniformly discouraged.

Another example is: The analyst should feel free to seek
consultation ... this should be considered in difficult cases. This is stated without spelling out what constitutes a difficult case. The new standard is that it is ethical and necessary for an analyst to seek consultation when there is a difficulty in a case, not just to consider the possibility. Difficulties may include persistent confusing or disturbing feelings of the analyst, or a request by the patient for a consultation.

The same is true when there is a question of competence. The old code states that when disorder within the psychoanalyst threatens the quality of the work, analysts should avail themselves of remedial measures, although none are specified. At this time it is not enough to consider the possibility of the analyst getting help. It is an imperative that there be intervention in a deteriorating situation, whatever the cause of the deterioration. As far as physical or mental disorders of an analyst or unethical behavior, it is much more the collective duty of the profession to be aware of the deterioration and to intervene, even if the analyst is unaware or unwilling to have any intervention.

In the old code while sexual relationships with patients were unacceptable, marriage was not mentioned. In the new code it is unethical to have sexual relations with or to marry either a current or former patient, or the parents or guardians of such patients.

There is a general warning about avoiding instances of taking advantage of the inequalities of the transference relationship to exploit patients or relatives of patients in any way. This includes sexual, financial, influence in group dynamics, or in any other way. The analyst should not have any financial dealings with the patient except the payment of the fee. The analyst must not solicit or accept gifts, even for a worthy purpose such as a foundation supporting analytic work. Even bequests should be donated promptly to an entity in which the analyst exerts no control. The inequalities of the transference situation and the opportunities that this presents for exploitation are emphasized. It is no longer no one' s business what goes on in analysts' offices, but rather, there is a collective responsibility to safeguard the public and the reputation of the profession.

There is also an emphasis now on being aware of biases that may interfere with doing competent work with respect for persons. It cannot be assumed that people of general good will and intentions do not have biases. Bias or prejudice is something to be aware of enough to prevent its interference with good analytic work.

In summary, Ethical responsibility is more communal, widely defined and focused on continual self monitoring.

In order to implement the aspect of the code that involves communal responsibility the Executive Board of PANY has been discussing the idea of setting up a Colleague-Patient Assistance Committee that would function as a resource for anyone concerned with a problem in analytic treatment. Confidential consultations would be offered and if necessary, mediation would be available. Anyone interested in participating in such efforts may call Dr. Rita Clark for further information.